Facilitators and barriers of breastfeeding late preterm infants according to mothers’ experiences

Abstract

BackgroundLate preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants.MethodsWe conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7 weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected.ResultsA total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94 % of infants, with exclusively human milk being fed in 43 % of cases; exclusively formula was fed to 6 % of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (OR = 2.73, 95 % CI 1.05–7.1, p = 0.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (OR = 0.46, 95 % CI 0.2–1.06, p = 0.07).ConclusionsBased on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants.

Breastfeeding Characteristics of Late-Preterm Infants in a Kangaroo Mother Care Unit

“…25 Immaturity in sucking and swallowing were also expected, given previous research indicating that neurological immaturity in LPIs may impact on these characteristics, and that coordinating these with breathing, only matures and is refined in the third trimester. 5,14,27,28 The suck-swallow-breathe ratio for efficient breastfeeding in term infants is 1-1-1, to 3-1-1. 24 Less frequent swallowing may indicate poor milk transfer.…”

Are there interventions that improve breastfeeding and the use of breast milk in late preterm infants?

“…Late preterm infants, defined as infants born at 34 + 0 to 36 + 6 weeks' gestation, account for a large portion of preterm births and approximately 5–10% of all births . The size of this population means that changes in practice are likely to have a major impact on health outcomes and health‐care resources …”

“…The health benefits of breast milk for infant nutrition are well researched, and exclusive breastfeeding is recommended in the first 6 months of life . The advantages conferred by breast milk feeding are equally, if not more, important in the late preterm group .…”

“…Research shows that preterm infants are less likely to initiate breastfeeding and achieve exclusive breastfeeding compared with term infants . Breastfeeding late preterm infants presents several challenges; they may be sleepier and have reduced muscle strength and therefore have more difficulty with latch, suck and swallow .…”

“…A 2016 Cochrane review concluded that there is low‐quality evidence that health‐care professional‐led and non‐health‐care professional‐led education and peer support result in some improvement in the number of women who initiate breastfeeding . There appears to be a paucity of literature examining the factors affecting breastfeeding practices of late preterm infants . This is particularly true for literature relating to interventions to improve breastfeeding in this cohort.…”